ED Muskoka Physicians - Living the Dream

Updates from Antibiotic committee meeting

Hi team

A few updates from the Antimicrobial stewardship committee meeting today. Exciting I know.
1. FYI – Peritoneal Dialysis patients presenting with ?SBP – there are NO nurses at MAHC authorized to access these PD catheters to obtain a sample (as per discussion with OSMH & RVH dialysis staff). Appropriate management includes a stat phone call to Nephrology to arrange for transfer for workup and management. Empiric antibiotic choices should be discussed with Nephro prior to transfer.
2. Several new ordersets have been drafted and are going to P&T, look out for these to be posted soon to Entrypoint. Hopefully they are helpful and less burdensome than that awful general sepsis orderset we used to have:
  1. 1) Endocarditis Order Set

    2) Meningitis Order Set
    3) Diabetic Foot Order Set
    4) Spontaneous Bacterial Peritonitis Order Set

    5) Acute Diverticulitis

    6) Necrotizing Soft Tissue Infection

    7) Febrile Neutropenia
    8) CDI Order Set and PR Administration of Vanco

There is also a document entitled:  “Intraabdominal Infections” that is NOT an orderset but provides useful evidence-based info on appropriate antibiotics to select. It will be posted to ENTRYPOINT to use as reference if you wish to access it when writing orders (or send your med students to find it to do some ‘self-study’ time!)
 
If there are other infection-related order sets you would like to see (or if you think a review of the literature is required on any current ones) please let me know and I can bring to committee!
 
 
Lastly, nothing to do with antibiotics, but if you weren’t at pharmacy rounds the other week an interesting tidbit of info that came up: Did you know that our hospital spent over $12 000 on the Zofran ODT wafers last year? If we had subbed every ODT dose for a PO dose we would have spent just over $600.  I forget the exact numbers but the PO dose is somewhere around $0.11 and ODT is over $2.00, IV dose is under $1.00. Interestingly, the ODT is NOT buccally absorbed, it just dissolves and then has to be swallowed and is absorbed in the GI tract just like the PO dose (still takes about 30min) – so my takeaway is that (except for in kids where swallowing a pill is an issue) if the patient can’t take PO, just give IV and skip the ODT!
 
Enough for today, enjoy your weekend everyone.
 
Kirsten
 
 
ps – yes, we are still waiting on baby to arrive!

Process Improvements in The Emergency Department

A good read from an Ontario ED

Click Here

Ghana Mission Trip

Hi All,

Copy and paste this to your browser and take a look at this video.

http://grid-nea.org/grid-2015-medical-team/

This is the health team mission group I will be part of this year joined by two fantastic locals Helen Dempster and Cheryl Dove and 57 teammates!!!

I am selling Muskoka Coffee still as a fundraiser to buy supplies for the mission trip.

I have about 30 bags left ( several kinds) of Muskoka coffee.
$16 a bag ( like the store) and I get 5 dollars of that for the team . This five dollars then becomes $7.50 with the help of a team grant.

Let me know what coffee you would like!!

John

Pediatric urgent psych referrals (RVH)

Just a quick reminder (which was new information for me tonight) – for our adolescent mental health patients we can make a referral to the psych “Urgent Consult Clinic” at RVH. This is for adolescents ages 12-17 who are safe to be discharged but need psych follow up within 48h (ideally). They will be seen either in person or by OTN by a multidisp. team of an RN, social worker, and psychiatrist. This is supposed to be a one-time visit for consult & recommendations only.

Referral forms can be found in the MENTAL HEALTH BINDER in Huntsville (apparently there is a specific urgent consult clinic binder somewhere in Bracebridge too? We couldnt find it in Huntsville tonight)

Thought I’d pass this along as I’m pretty sure I had never heard of this service before and it sounds useful!

Huntsville Emergency Physician Group – Clinical Leave / LOA 2016 and 2017

Hi All HDMH Physicians,

As per the group governance agreement, physicians can take clinical leave / leave of absences from time to time to pursue other activities (e.g. extended vacation, volunteering, locum work).  This arrangement allows all of us to do interesting things that we would otherwise not be able to do while also maintaining our group commitments.

A number of us have informally agreed that it would be nice to keep a list of when other group members are away so that we can coordinate leave and ensure good ED coverage.  Below is a simple list of the remaining months in 2016 and 2017 with known clinical leaves and leaves of absence.  If you have a leave of absence that you would like to make the group aware of please add a reply to this thread and I will update it from time to time (My apologies to the SMMH physicians but I think you can choose not to follow this thread).  If we would like to extend this to include vacations so we can coordinate that I think we can discuss it at a future group meeting.  Thanks for your help.

 

Huntsville Emergency Physicians Clinical Leave 2016 & 2017

 

2016

October

November – John Simpson – Full Month Mission Trip Ghana

December

 

2017

January

February – Tyler Johnston – Full Month EM Residency Teaching Haiti

March

April

May

June

July

August

September

November

December

New gear for trauma …

Hi Guys,

 

Just wanted to throw out a couple ideas to improve our trauma care …

  1. Tourniquets

Pierre had a gunshot extremity the other day and it would have been very useful to have one of these which are pretty cheap https://www.amazon.com/Application-Tourniquet-Improved-Version-American/dp/B00MA6XVVC.  I think Bob is looking into this but I think the group should support him in this regard and have Kathy and Nancy support him so that both sites have access to three or four of these very useful items ..

2. Pelvic Binders

Had a reason to use one of these the other day and frankly sheets are tuff to make stay … I like the T-pod best but it is expensive and some interventionalists don’t like them when they are trying to do immobilization but what can you do …

Here’s a quick link … http://www.trauma.org/index.php/main/article/657/

T-Pod -http://www.pyng.com/products/t-podcombat/

Would love to know what others think about these ideas…

Take care,

Tyler

A nice link on extensor tendon repair …

Hi All,

In case you haven’t done one of these in a while …

I am still not sure I am going to stop a busy shift for 30+ minutes sometimes to do these but here’s a nice

link with nice videos on extensor tendon repair https://www.aliem.com/2016/extensor-tendon-injuries-hand/

TJ

North Bay

Good Morning Gang,

I am sitting in North Bay ER presently and have just met some wonderfull docs and been learning about their schedule, department, etc.
They do need locums if anyone interested and are currently working on jan schedule if anyone interested. Subacute and acute sides ( 5 hours shifts to 9 hour shifts). KMs paid at 41 cents per km, free accomadation if you are staying over, and pay about $163 per hour ( details still to come) plus the 33% afa payment.
Talk to me direct if interested!!

John

Literature Drive By

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Lung Ultrasound

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